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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202415
Report Date: 06/13/2024
Date Signed: 06/13/2024 04:35:46 PM

Document Has Been Signed on 06/13/2024 04:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:CASA ALICE CARE HOMEFACILITY NUMBER:
435202415
ADMINISTRATOR/
DIRECTOR:		PING JING ZHAOFACILITY TYPE:
740
ADDRESS:809 ALICE AVENUETELEPHONE:
(650) 279-7488
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 6CENSUS: DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Becky BiTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Becky Bi.

During visit, LPA Marrufo conducted interviews with 2 staff and 2 residents.

LPA Marrufo tested the detectors of smoke and carbon monoxide in each bedroom and hallway and each detector functioned properly when tested.

LPA Marrufo toured 6 out of 6 resident bathrooms. Each bathroom had water temperatures between 105 F to 108 F. Each bathroom had available soap and paper towels. LPA toured 6 out of 6 resident bedrooms and each bedroom had working lights and available bedding and clothing storage areas.

Due to time constraints, the annual inspection will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Administrator Becky Bi and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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